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免疫性血小板减少具有血小板破坏加速与血小板表面结合免疫球蛋白增加,已见于慢性淋巴细胞性白血病和淋巴瘤。免疫性血小板减少与癌肿伴发尚属罕见。作者报告3例癌并发血小板减少,定量测定血小板相关IgG(PAIgG)和血小板相关IgM(PAIgM)均增加。例1:40岁,女性。病理活检证实为肺分化不良腺癌。血小板48,000/mm~3,每个血小板的PAIgG增高达10.8、PAIgM达100fg。癌胚抗原阴性,抗核抗体1:40阳性。骨髓穿刺及活检显示巨核细胞增多。服强的松80mg/d,第10天血小板升至89,000/mm~3。脾切除后,服强的松5mg/d,血小板数超过150,000/mm~3。联合化疗两周后PAIgG正常,PAIgM仍高达14.3fg。
Immune thrombocytopenia with accelerated platelet destruction and platelet surface binding immunoglobulin increased, have been found in chronic lymphocytic leukemia and lymphoma. Immune thrombocytopenia and cancer is still rare. The authors report 3 cases of cancer with concurrent thrombocytopenia, and quantitative determination of platelet-associated IgG (PAIgG) and platelet-associated IgM (PAIgM) increased. Example 1: 40 years old, female. Biopsy confirmed pulmonary dysplasia adenocarcinoma. Platelets 48,000 / mm ~ 3, PAIgG per platelet increased up to 10.8, PAIgM up to 100fg. Carcinoembryonic antigen negative, antinuclear antibodies 1:40 positive. Bone marrow aspiration and biopsy showed megakaryocytosis. Prednisone 80mg / d, the first 10 days platelets rose to 89,000 / mm ~ 3. After splenectomy, prednisone 5mg / d, platelet count over 150,000 / mm ~ 3. After two weeks of combination chemotherapy PAIgG normal, PAIgM still up to 14.3fg.